Spector A, Orrell M, Davies S, Woods B
University College London, Department of Clinical Health Psychology, 1-19 Torrington Place, London, UK, WC1E 6BT.
Cochrane Database Syst Rev. 2007 Jul 18;2000(3):CD001119. doi: 10.1002/14651858.CD001119.pub2.
Reality Orientation (RO) was first described as a technique to improve the quality of life of confused elderly people, although its origins lie in an attempt to rehabilitate severely disturbed war veterans, not in geriatric work. It operates through the presentation of orientation information (eg time, place and person-related) which is thought to provide the person with a greater understanding of their surroundings, possibly resulting in an improved sense of control and self-esteem. There has been criticism of RO in clinical practice, with some fear that it has been applied in a mechanical fashion and has been insensitive to the needs of the individual. There is also a suggestion that constant relearning of material can actually contribute to mood and self-esteem problems. There is often little consistent application of psychological therapies in dementia services, so a systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base.
To assess the evidence of effectiveness for the use of Reality Orientation (RO) as a classroom-based therapy on elderly persons with dementia.
Computerised databases were searched independently by 2 reviewers entering the terms 'Reality Orientation, dementia, control, trial or study'. Relevant web sites were searched and some hand searching was conducted by the reviewer. Specialists in the field were approached for undocumented material, and all publications found were searched for additional references.
All randomized controlled trials (RCTs), and all controlled trials with some degree of concealment, blinding or control for bias (second order evidence) of Reality Orientation as an intervention for dementia were included. The criteria for inclusion/exclusion involved systematic assessment of the quality of study design and the risk of bias, using a standard data extraction form. A measure of cognitive and/or behavioural change was needed.
Data were extracted independently by both reviewers, using a previously tested data extraction form. Authors were contacted for data not provided in the papers. Psychological scales measuring cognitive and behavioural changes were examined.
6 RCTs were entered in the analysis, with a total of 125 subjects (67 in experimental groups, 58 in control groups). Results were divided into 2 subsections: cognition and behaviour. Change in cognitive and behavioural outcomes showed a significant effect in favour of treatment.
AUTHORS' CONCLUSIONS: There is some evidence that RO has benefits on both cognition and behaviour for dementia sufferers. Further research could examine which features of RO are particularly effective. It is unclear how far the benefits of RO extend after the end of treatment, but and it appears that a continued programme may be needed to sustain potential benefits.
现实定向疗法（RO）最初被描述为一种改善意识混乱老年人生活质量的技术，尽管其起源于试图使严重精神错乱的退伍军人康复，而非老年病学工作。它通过呈现定向信息（如时间、地点和与人物相关的信息）来发挥作用，这些信息被认为能让患者更好地了解周围环境，可能会增强其控制感和自尊心。在临床实践中，RO受到了批评，有人担心它被机械地应用，且对个体需求缺乏敏感性。也有人认为不断重新学习这些内容实际上可能会导致情绪和自尊问题。在痴呆症服务中，心理治疗方法的应用往往缺乏一致性，因此对现有证据进行系统综述对于确定不同疗法的有效性很重要。随后，可以在可靠的证据基础上制定使用这些疗法的指南。
评估将现实定向疗法（RO）作为一种基于课堂的疗法用于老年痴呆症患者的有效性证据。
两名评审员独立检索计算机化数据库，输入检索词“现实定向疗法、痴呆症、对照、试验或研究”。检索了相关网站，评审员还进行了一些手工检索。向该领域的专家咨询未发表的资料，并对所有找到的出版物进行进一步参考文献检索。
纳入所有随机对照试验（RCT），以及所有对现实定向疗法作为痴呆症干预措施具有一定程度的隐匿、盲法或偏倚控制（二级证据）的对照试验。纳入/排除标准包括使用标准数据提取表对研究设计质量和偏倚风险进行系统评估。需要有认知和/或行为变化的测量指标。
两名评审员使用预先测试过的数据提取表独立提取数据。就论文中未提供的数据与作者进行了联系。对测量认知和行为变化的心理量表进行了检查。
6项RCT被纳入分析，共有125名受试者（实验组67名，对照组58名）。结果分为两个子部分：认知和行为。认知和行为结果的变化显示治疗有显著效果。
有证据表明现实定向疗法对痴呆症患者的认知和行为都有益处。进一步的研究可以考察现实定向疗法的哪些特征特别有效。目前尚不清楚治疗结束后现实定向疗法的益处能持续多久，但似乎可能需要一个持续的方案来维持潜在的益处。
